儿童第四脑室肿瘤显微外科治疗及手术后并发症的预防

Microsurgery of Forth Ventricle Tumors and the Prevention of Postoperative Complications

背景与目的:儿童第四脑室肿瘤术后易出现的枕部皮下积液或假性脑膜膨出、切口脑脊液漏、颅内感染等并发症。本文探讨儿童第四脑室肿瘤手术计划的制订,以提高手术疗效。方法:2006年5月以来26例第四脑室肿瘤患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;经膜髓帆入路手术切除儿童第四脑室肿瘤。结果:所有患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;肿瘤全切23例,次全切除3例,无一例出现缄默症,本手术组无死亡病例。6例颅内感染者得到有效控制,无一例出现脑积水而需要行分流术,未出现一例枕部假性脑膜膨出及切口脑脊液漏等并发症。结论:多数儿童第四脑室肿瘤患者可经膜髓帆入路在不需要切开小脑蚓部的情况下予以肿瘤切除,仅少数患者为了充分显示肿瘤上极而切开小脑下蚓部。术前安置Ommaya囊术后持续外引流,可以有效地预防并发症的发生。

BACKGROUND OBJECTIVE： The improvement of removal extent and minimizing postoperative complications are the goal of neurosurgical treatment of forth ventricle tumors.In this article,we discussed the surgical planning of the resection of fourth ventricle tumors in children,and to improve the effect of surgery.METHODS： The clinical data of 26 patients with forth ventricle tumors（since May 2006） resected through telovelar approach were retrospective analyzed.RESULTS： Before tumor resection,an Ommaya reservoir was placed inside the ventricular on the right forehead in all patients,which was used for intraoperative and postoperative external CSF drainage.In all patients,23 cases received total resection,3 cases received subtotal resection,no mutism or death was seen in this group.Six patients with intracranial infection was effectively controlled.No ventriculoperitoneal（VP） shunt was needed because of hydrocephalus,and no pseudomeningocele or leakage of cerebrospinal fluid was found.CONCLUSIONS： Most patients with forth ventricle tumors can be removed through trans-telovelar approach without dissection of the vermiform process of cerebellum.The vermiform process of cerebellum was dissected only in a few patients in order to expose the upper pole of the tumor.The placement of Ommaya reservoirs before surgery can keep drainage throughout postoperative stage,and effectively reduced the development of complications.